Pituitary gland protocol (MRI)

MRI protocol for pituitary gland is a group of MRI sequences put together to improve sensitivity and specificity for the assessment of lesions of the pituitary gland (e.g. pituitary adenoma) and other sellar and suprasellar abnormalities (check the article on pituitary region masses for some examples). 

MRI is nowadays the imaging procedure of choice for the pituitary gland assessment, largely replacing CT, which is currently reserved to the assessment of bone destruction and surgically relevant bone anatomy 1. See: history of imaging the pituitary region.

To review a systematic approach to the pituitary region, please refer to the article on pituitary MRI (an approach).

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 

Sequences

The sequences for this purpose should be performed with small FOV targeting the sella. A good protocol for this purpose involves at least:

  • T1
  • T2
    • sequence: usually coronal, but axial or sagittal can also be useful with high resolution/thin slices 
    • purpose: identify blood product or dot sign in Rathke's cleft cysts
  • T1 C+ dynamic
    • sequence: small FOV coronal, obtained at multiple locations through the pituitary gland (e.g. 6) at multiple times (e.g. 0, 30, 60, 90, 120 and 180 seconds)
    • purpose: useful to identify microadenomas (which have delayed enhancement) and identify displaced normal pituitary gland by a sellar mass, and to help distinguish between residual or recurrent tumour from postoperative tissues 1
  • T1 C+ delayed
    • sequence: small FOV coronal and sagittal (same as T1 non-contrast)
    • purpose: valuable to assess the cavernous sinuses and to characterise other sellar region tumours

Some institutions also include some whole brain sequences (e.g. DWI/ADC and FLAIR). 

MRI protocols
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rID: 50127
Synonyms or Alternate Spellings:
  • MRI protocol for assessing the sellar region
  • Sellar region MRI protocol

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